NPIMap

Organization Active NPI

Augusta University

Doing business as Augusta University Athletics

  • Sports Medicine (Family Medicine) Physician
  • Augusta, GA
National Provider Identifier
1215711155
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
Legal business name
AUGUSTA UNIVERSITY
Doing business as
Augusta University Athletics
Practice address
1120 15TH St # B132
Augusta, GA 30912-0004
Phone
(972) 367-4845
Fax
(972) 367-3451
NPI assigned
Aug 22, 2023
Last updated
Aug 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mouzon Bass III
Title
Administrator/Agent
Phone
(972) 367-4845

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X NU Primary

Addresses

Primary practice location

1120 15TH St # B132
Augusta, GA 30912-0004

Mailing address

15305 Dallas Pkwy Ste 800
Addison, TX 75001-6415
Phone (972) 367-4845

Other names 1

  • AUGUSTA UNIVERSITY ATHLETICS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Augusta University9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1120 15th St
#B132
Augusta, GA 30912

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692662400000",
    "number": "1215711155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15305 DALLAS PKWY STE 800",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750016415",
            "telephone_number": "972-367-4845",
            "fax_number": "972-367-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 15TH ST # B132",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309120004",
            "telephone_number": "972-367-4845",
            "fax_number": "972-367-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUGUSTA UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-22",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "MOUZON",
        "authorized_official_title_or_position": "ADMINISTRATOR/AGENT",
        "authorized_official_telephone_number": "972-367-4845",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AUGUSTA UNIVERSITY ATHLETICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.